Information Collection

Notification Of Suspension Or Revocation Of License Of A Practitioner

IC 119964 under ICR 198108-1117-005 · OMB 1117-0002.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

NOTIFICATION OF SUSPENSION OR REVOCATION OF LICENSE OF A PRACTITIONER

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DEA 276				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,000	3,400	600
Annual IC Time Burden (Hours)	680	580	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.